EXCISE TAX EXEMPTION CERTIFICATE

(Date) ______________/_____________, 20 _____.

I hereby certify that I am ______________________________ of ______________________________;
                                 (Title of Officer)            (State or Local Government)

That I am authorized to execute this certificate; and that the article or articles specified in the
Accompanying order (or) All orders placed by the purchaser for the period commencing

_____/_____/_____ And ending ______/_____/______ (period not to exceed 12 Calendar quarters) are,
     (Date)                        (Date)

Or will be, purchased from ________________________________________ For the exclusive use of the
                                  (Name Of Manufacturer)

__________________________________________, Of ___________________________________.
           (Governmental Unit)                     (State or Local Government)

I understand that the exemption from tax in the case of sales of articles under this exemption certificate to
a State, etc., is limited to the sale of articles purchased for its exclusive use. I understand that fraudulent
use of this certificate for the purpose of securing this exemption will subject me and all parties making
such fraudulent use of this certificate to all applicable criminal penalties under the Internal Revenue Code.

Signature: ______________________________________________________________________

Address: _______________________________________________________________________

City: __________________________State: ______________Zip: _________

Phone: ________ / _______ - __________ Fax: ________ / _______ - ________

A sale of an article to a State or local government for resale is not considered to be a sale for the
“exclusive use” of State or local government, within the meaning of section 4221 (a) (4) of the code, and,
therefore, such sales may not be made tax-free. Such sales may not be made tax-free even if the reseals
are made to government employees, or the article is an item of equipment the employee is required to
possess in carrying out his/her duties.


Please mail original To:
Florida GunWorks
8306 Mills Drive, #571
Miami, FL  33183